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Does Medicare Cover Orthopedics and Orthopedic Shoes?

"Does Medicare Cover Orthopedics and Orthopedic Shoes?" text over image of orthopedics sign

Orthopedics are covered by Original Medicare, but that coverage can be limited. Give one of our experienced, licensed agents a call today at (800) 950-0608 to learn more about Medicare plans that may offer more coverage options for orthopedic services.

Just the Essentials:

  • Original Medicare does cover orthopedics and orthopedic shoes.

  • In order to have orthopedic services covered by Original Medicare, you must first meet the $233 deductible.

  • You pay 20 percent coinsurance for orthopedic services after meeting your deductible.

  • Medicare Advantage and Medigap supplemental insurance can help you cover what Original Medicare may not.

Are Orthopedics Covered By Medicare?

Original Medicare covers the treatment of a number of health conditions for seniors, but the caveat is that it may not cover them completely. While Original Medicare – Medicare Part A and Medicare Part B – manage to help you pay for the majority of treatments, whether inpatient or outpatient, that you may need, there are some gaps in the coverage. This is especially true for those who need treatment for orthopedic issues.

Medicare Part B is the primary part of Original Medicare that offers coverage for orthopedics. However, there’s a slight catch to when your Medicare coverage will kick in for orthopedic treatments. Read on to learn more about what Medicare will or will not cover when it comes to orthopedics.

Areas of Orthopedic Specialty

As we age, we start to see degradation in our bones, joints, ligaments, muscles, and tendons. These things begin to weaken, limiting your strength and mobility in varying degrees of severity. When you begin to notice issues with these parts of your body, that’s when you may decide to seek orthopedic treatment.

Orthopedic doctors are specialists in diagnosing and treating issues with the musculoskeletal system. The areas that they tend to focus on are as follows:

  • Bone health
  • Arthritis
  • General orthopedics
  • Orthopedic oncology
  • Sports medicine
  • Surgical procedures dealing with the musculoskeletal system, which include:
    • Foot and ankle surgery
    • Hand surgery
    • Hip and knee replacement surgery
    • Shoulder and elbow surgery
    • Spinal surgery
    • Trauma surgery

Does Medicare Cover Orthopedic Doctors?

If you’re in need of treatment for orthopedic conditions, you may be wondering: does Medicare cover orthopedic doctors?

The good news is that, yes, Medicare covers orthopedic doctors.

The bad news is that, until you meet the Medicare Part B deductible, you’ll be paying the majority of your costs for orthopedic treatment out-of-pocket. Once you meet the deductible, you’ll still be paying 20 percent of coinsurance for orthopedic treatment and services.

Let’s say, for example, you’re noticing some moderate muscle weakness. It’s not severe enough to keep you from performing daily activities, but it does hamper your ability to sustain repeated movements or lift moderately heavy things that you couldn’t lift before. You choose to seek out and visit an orthopedic specialist for treatment.

You’ll have to cover the cost for your first visits to your doctor, and after you’ve met the $233 Medicare Part B deductible, you’ll be responsible for 20 percent of the cost for each visit. This does not count the medications that you may be prescribed for your condition, as Original Medicare does not cover the cost of most prescription medications.

If you need certain orthopedic supplies, such as orthopedic leg braces or shoes, Medicare Part B may cover the cost. We’ll have more information on the coverage provided for orthopedic shoes later in the article.

Does Medicare Cover Orthopedic Surgery?

You’ve learned that Medicare covers orthopedic surgery, and you understand the conditions that come with this coverage. Still, you may have other questions on your mind about Medicare coverage and orthopedics, such as, “Does Medicare cover orthopedic surgery?”

Original Medicare does provide coverage for orthopedic surgery. The $233 deductible rule for Part B stays in place, even if you’re needing to visit an orthopedic surgeon for a complex surgery, such as a knee or hip replacement. The hospital insurance part of Original Medicare, Medicare Part A, will cover the time you spend in the hospital without coinsurance once you meet the $1,556 Part A deductible over a period of the first 60 days of your inpatient treatment.

Does Medicare Cover Orthopedic Shoes?

If you have orthopedic issues with your legs or feet, you may need orthopedic shoes to help you maintain your mobility. So, does Medicare cover orthopedic shoes? The answer is “yes”, but only if your doctor participates in the program.

Further, Medicare will only cover the cost of your orthopedic shoes if they’re a necessary part of leg braces. What does this mean? It essentially means that your doctor will have to prescribe leg braces and orthopedic shoes as a combo deemed medically necessary to help you maintain your mobility. Prescribing orthopedic shoes only without the need for leg braces will not count.

If your prescription for orthopedic shoes meets that standard, you’ll need your orthopedic specialist and their supplier to be an active participant in the Medicare program. This ensures that you’ll only be charged the coinsurance and Medicare Part B deductible for your orthopedic shoes. Suppliers who do not accept Medicare assignment may charge you any amount for your orthopedic shoes.

Original Medicare Isn’t Covering My Complete Needs for Orthopedics. Is Extra Help Available?

You have a number of options to help you get the extra coverage you need for orthopedic treatments. One of the most common ways to get extra assistance is to enroll in a Medigap supplemental insurance plan, or any other Medicare supplemental insurance plan.

Medigap plans are essentially here to help you “fill in the gaps” left open by what Original Medicare would not cover. If you’ve recently had an orthopedic surgical procedure and still found the 20 percent coinsurance rate to be high, a Medigap plan can vastly reduce or eliminate your out-of-pocket costs. The same rings true for visits to any orthopedic doctor.

Medicare Part D plans can help you cover the cost of needed medications for orthopedic conditions. However, this brings us back to one’s need for orthopedic shoes. If Medicare Part B won’t cover the cost of orthopedic shoes, how can you find help with paying for those?

Medicare Advantage plans, also known as Medicare Part C, are privately-held plans approved by the federal government that are designed to cover everything that Original Medicare typically covers, plus more. Aside from helping you cover the cost of orthopedic shoes, a Medicare Advantage plan can help you:

  • Cover transportation to and from orthopedic specialist appointments
  • Cover other orthopedic medical supplies typically not covered by Original Medicare
  • Cover more of the cost of orthopedic surgical procedures and treatments

Whether you’re in need of orthopedic shoes or other complex treatment, there’s a Medicare plan out there that can help you. If you need assistance covering orthopedics, but are unsure of whether or not there are Medicare plans out there that can help, reach out to one of our experienced, licensed agents today. They can help you find a Medicare plan in your area that may be able to help you cover the orthopedic treatments you need.

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